Steroids Significantly Decrease Postoperative Postural Hypotension in Total Knee Replacement.

Total knee replacement (TKR) is one of the most common orthopaedic procedures performed, and enhanced recovery after surgery (ERAS) has been developed and incorporated into inpatient surgical pathways to improve patient outcomes. Under ERAS recommendations, multimodal prophylaxis has been used to help manage postoperative nausea and vomiting (PONV) following TKR. Dexamethasone is one of the commonly used for this and the anti-inflammatory properties could depress vagal activity, reducing postural hypotension (PH). The hypothesis of this study is that postoperative dexamethasone use is associated with lower rates of early postoperative PH following TKR surgery. In our institution, patients who undergo elective primary TKR are admitted on the day of surgery and follow a standardized ERAS protocol. Data on patients who underwent elective primary TKR under a single adult reconstruction team from September 2017 to March 2020 were reviewed and analyzed. A review of demographic characteristics, surgical data, postoperative medications, and postoperative notes was performed. Binary logistic regression was used to assess the effect of the use of dexamethasone on PH, with an adjusted odds ratio (OR) calculated after accounting for potential confounders. Of the 149 patients were included in the study, 78 had dexamethasone postoperatively, and 71 did not. Patients who had received dexamethasone were statistically less likely to suffer from PH (OR = 0.31, p = 0.03) and less likely to develop PONV (OR = 0.21, p = 0.006). Patients who had received dexamethasone were more likely able to participate in early physiotherapy (OR = 2.42, p = 0.14), and this result was statistically insignificant. The use of postoperative intravenous dexamethasone is significantly associated with lower rates of postoperative PH after TKR. However, more studies are required to assess the optimal dosing amount and frequency, as well as to assess other factors which can enhance early postoperative patient mobilization as part of our goals for ERAS. This therapeutic study reflects level of evidence III.

Intranasal Steroid Use and Satisfaction in Allergic Rhinitis: A Cross-Sectional Study from an Asian Perspective.

BACKGROUND: Intranasal steroid (INS) is the most effective medication class for controlling allergic rhinitis (AR) symptoms; however, its effectiveness is limited by patient compliance. Previous studies have explored INS use, compliance, satisfaction, and experience. There is, however, no Asian study on these factors in entirety. OBJECTIVE: We aimed to investigate the rate of compliance to usage of INS and explore the reasons for noncompliance in our local population. METHODS: We conducted a prospective cross-sectional study on 65 AR patients in a tertiary hospital. Recruited patients were administered a questionnaire to collect data about symptoms, INS use, and concerns they may have. Statistical analysis was performed using SPSS. RESULTS: The overall compliance rate to INS was 63.1%. Noncompliance was associated with increased frequency of dosing (p = 0.050), presence of sensory attributes (p = 0.041), and forgetfulness (p = 0.049). The top 3 most frequent sensory attributes experienced by patients include throat rundown (29.2%), aftertaste (21.5%), and immediate taste (20.0%). There was a significant difference between brands of INS with regard to sensory attributes experienced (p = 0.003) but no side effects (p = 0.070). CONCLUSIONS: Identifying risk factors for noncompliance to INS can help health-care providers address difficulties faced by patients and hence increase compliance, allowing better control of AR symptoms.

Under the influence of alcohol: the effect of ethanol and methanol on lipid bilayers.

Extensive microscopic molecular dynamics simulations have been performed to study the effects of short-chain alcohols, methanol and ethanol, on two different fully hydrated lipid bilayer systems (POPC and DPPC) in the fluid phase at 323 K. It is found that ethanol has a stronger effect on the structural properties of the membranes. In particular, the bilayers become more fluid and permeable: ethanol molecules are able to penetrate through the membrane in typical timescales of approximately 200 ns, whereas for methanol that timescale is considerably longer, at least of the order of microseconds. A closer examination exposes a number of effects due to ethanol. Hydrogen-bonding analysis reveals that a large fraction of ethanols is involved in hydrogen bonds with lipids. This in turn is intimately coupled to the ordering of hydrocarbon chains: we find that binding to an ethanol decreases the order of the chains. We have also determined the dependence of lipid-chain ordering on ethanol concentration and found that to be nonmonotonous. Overall, we find good agreement with NMR and micropipette studies.